BURSARIES Application Form Please print and complete this form For Office Use: Discipline: Category: PASSPORT PHOTO (Black and White) Code: APPLICATION FOR ANGLO PLATINUM BURSARY Please complete the application form as thoroughly as possible in BLACK INK and send it to: The Bursaries Department Anglo Platinum Development Centre P.O. Box 450, KROONDAL, 0350 CLOSING DATE: 15 May If you have not received correspondence relating to this application from Anglo Platinum by 31 July of the year of application, you can assume that your application has been unsuccessful NOTES AND INSTRUCTIONS (Read these notes carefully before you complete the application form) 1. Make sure that you read every section and that the information you provide is accurate. 2. INCOMPLETE APPLICATION FORMS WILL NOT BE CONSIDERED. 3. Bursaries will only be allocated for the year following the one in which the application was received. 4. Your application will not be considered if you do not furnish proof of your academic results and full details of your academic record. Results for the academic year should accompany this application and must not be submitted separately. 5. Do not send original documents. Attach required certified copies at the back of the application form. 6. A passport-size photograph of the applicant must be attached to the application form in the allocated space. 7. Original Application Forms must be submitted. Forms submitted via electronic media will not be accepted. 8. The minimum selection requirements are Grade 12 C (HG) and B (SG) for mathematics and science (science not required for Finance/Accountancy)
PART 1 APPLICATION DETAILS State the career you wish to follow: _ Name the degree or diploma you intend to study: Are you currently registered at a University/Technikon for this course? Study year for which you will be registered next year (e.g. first, second) Name of proposed University/Technikon: Have you applied for a bursary with Anglo Platinum before? If yes to the above, state which discipline and when: Have you applied to other company/ies for a bursary? State which company/ies: _ PART 2 PERSONAL Surname: First Names: Gender: Male Female Date of birth: I.D. Number: Nationality: RSA Other If other, please specify: Do you have a permanent residence permit? If so, please state the permanent residence permit number: Married Single (for accommodating purposes) Size of shoe/boot: Overall Size: _ (This information is needed should you be invited for a mine visit at one of our operations) Do you have a disability / any disabilities?
Name and complete address of your current/last school or tertiary institution Postal Code: Tel..: Dialing Code: Your Home Address Postal Code: Tel..: Dialing Code: Current postal address (only applicable if it is different from your school/home address) Postal Code: Tel..: Dialing Code: Person that we can contact if we need to contact you urgently: Name: Tel.. Dialing Code: Name of guardian: Relationship : Tel.. of parent or guardian: Contact address: Please indicate if either you or your parent/s have been or are employed by Anglo Platinum. Name Relationship (Mother/father) Department Occupation From To Should you qualify for a preliminary interview, it will take place at one of the centres below Indicate with an X the centre which is closest to your home, school or institution where you could be interviewed if required NB: Interviews will take place during June and July Cape Town Durban Johannesburg Middelburg Mmabatho Pietersburg Pietermaritzburg Port Elizabeth Potchefstroom Pretoria Rustenburg Welkom
Name of secondary schools you attended or are attending PART 3 EDUCATION Name of School Form To Grade completed Please state your results for Grades 10, 11 and 12 (please specify percentage) Subjects Mathematics Science English Others Grade 10 % obtained Grades Class Grade 11 Grades Class Grade 12 Grades HG/SG Ave. % obtained HG/SG Ave. % obtained HG/SG Class Ave. Kindly request your school to verify the above with their official stamp School Stamp Have you written your final Grade 12 exams? If yes, complete the following: of examination: Enter final symbols, if applicable: Subject HG/SG Symbol Subject HG/SG Symbol Mathematics Science English Others Aggregate Symbol:
TERTIARY EDUCATION A) CURRENT Name of University/Technikon: Currently registered in 1st 2nd 3rd 4th 5th academic year of study. Student Number: commenced: Number of practical semesters successfully completed if at Technikon: Degree / diploma course: B) PREVIOUS Have you previously attended University / Technikon? Name of University / Technikon: Student Number: Degree/diploma course: commenced: Have you repeated any year of study during your current or previous tertiary study If yes, state year, date and reason: Examination results: (Add supplementary sheet if space is insufficient) NB: ATTACH PROOF OR RESULTS 1 st year of study (state subjects) % obtained 2 nd year of study % obtained (state subjects) June Dec June Dec 3 rd year of study (state subjects) % obtained 4 th year of study % obtained (state subjects) June Dec June Dec Please furnish details if you are repeating any subjects:
PART 4 EXTRAMURAL ACTIVITIES Please supply details of the role you played in: School extra murals Community activities Please state your interests and hobbies: PART 5 CAREER Do you have currently have a scholarship, bursary or loan? If yes, what is the name of the award: Who has it been awarded by? What is the value of the award? Is there a service obligation attached to this scholarship, bursary or loan? Have you been employed since leaving school? Full time Part time If yes, give details and attach a record of service or testimonial. Details of current and/or previous employment: Employer Occupation From To
Have you ever visited a mine? If so, give us details of where, when and what your impressions where: Write a brief statement setting out clearly why you have chosen this career: DECLARATION I hereby give full consent to undergo any medical tests/examination required by ANGLO PLATINUM. 1. I confirm that the information contained in this application is, to the best of my knowledge, correct and truthful and I understand that if it is not, I may be eliminated from consideration in the selection process. If, after being admitted to the training scheme, any falsehoods or omissions are discovered in my application, I understand that my Training Agreement may be terminated. 2. I understand that all statements in my application may be investigated and I authorize the organization to contact the following persons who might be able to speak about my abilities and suitability for the bursary for which I have applied: 3. I understand that an investigation of me might include reference checks from my school / university / technikon / previous employer/s. I authorize any school/university and/or technikon/employer, to provide ANGLO PLATINUM with relevant information and opinions that may be useful in making a decision, and release such persons and organizations from legal liability in making such statements. (Please specify persons/institutions you would like us to contact.) 4. I hereby indemnify ANGLO PLATINUM Development Centre or any ANGLO Group Company, their Training Managers and Training Officials against any claim for illness or accidental injury sustained by me during a visit to their operations, should I be invited to attend such a visit. Signature of Applicant: Date:
FOR OFFICE USE ONLY RECEIPT / INITIAL SCREENING Official s Name: Official s Signature: Date: Decision: Comments: FINAL SCREENING Official s Name: Official s Signature: Date: Decision: Comments: PRELIMINARY INTERVIEW Official s Name: Official s Signature: Date: Decision: Comments: FINAL INTERVIEW Official s Name: Official s Signature: Date: Decision: Comments: